We are in the middle of planning for our new expansion facility and there are a couple of things that we must work out. We are going to start solid organ transplant in this new facility. I am hopping to gather some information from everyone to help us plan for what would work best for us. We are a Children’s hospital. We are going to have around 350 beds. We have a burn unit, stem cell unit, a large sickle cell outpatient population and we are bringing in CV Surgery.

• How do you deliver blood products to the OR and CV?
  
• Do you have a tube system or satellite blood bank? Do you have emergency power for the tube system?
  
• Does anyone use a Dumbwaiter to deliver a cooler of blood to OR?
  
• How do you handle a request for more than one unit for a patient?
  
• How do you handle specimens from the ER, OR and CV? Do they go directly to the Blood Bank?
  
• What is an acceptable TAT for the ER, OR and CV?
  

Thank you in advance for you help. James Ward

1. We deliver blood to the OR by pneumatic tube.

2. The pneumatic tube system is on emergency power, but if for some reason it was down, we would probably send someone up to the OR with the blood.

3. We don't have a dumbwaiter, and we don't use coolers here.

4. If the OR requests more than 1 unit, we send it. They understand that they should not order more than they need to.

5. Specimens from the OR for Type and Crossmatch are sent directly to the Blood Bank by pneumatic tube.

6. Our stat TAT is 60 minutes, but we can do it in 30 minutes (we have the gel). If they need blood sooner than that, we give them uncrossmatched O negatives.

• How do you deliver blood products to the OR and CV? We have portable, monitored refrigs on wheels that the surgery staff puts the blood in after they sign it out of the BB
  
• Do you have a tube system or satellite blood bank? Do you have emergency power for the tube system? No satellite BB, we have a tube system but don't tube blood through it. No it is not on emergency power
  
• Does anyone use a Dumbwaiter to deliver a cooler of blood to OR? No dumbwaiter but we do deliver blood in a cooler for traumas
  
• How do you handle a request for more than one unit for a patient? Only one unit of PC at a time for anyone except OR, ER, and dialysis. Anyone can have 2 FFP if they are running it in in <30 min or have 2 lines going.
  
• How do you handle specimens from the ER, OR and CV? Do they go directly to the Blood Bank? Specs go through the front desk, unless it's a super stat from OR or ED, they know than can drop it off directly with us.
  
• What is an acceptable TAT for the ER, OR and CV? 35-45 minutes for T&S with no antibodies, any of them can have 2 units uncrossmatched if they call
  

• How do you deliver blood products to the OR and CV?
  
• 
  
• Do you have a tube system or satellite blood bank? Do you have emergency power for the tube system?
  
• Does anyone use a Dumbwaiter to deliver a cooler of blood to OR?
  
• How do you handle a request for more than one unit for a patient?
  
• How do you handle specimens from the ER, OR and CV? Do they go directly to the Blood Bank?
  
• What is an acceptable TAT for the ER, OR and CV?
  

• How do you deliver blood products to the OR and CV?
  

If it is uncertain whether or not transfusion is imminent, the OR staff will come to the blood bank and pick up a cooler.

• Do you have a tube system or satellite blood bank? Do you have emergency power for the tube system?
  

We do have a pneumatic tube system and it is on emergency power. However it sometimes does go down. In this case, the floor must come down and get the blood. We send all of our blood through a secure transaction. The code we put in is the patient medical record number. Once sent to the floor, the receiving end must input this number to be able to get the blood out. This acts as a control as to who can get to the blood and that it will be received in a timely manner.

• Does anyone use a Dumbwaiter to deliver a cooler of blood to OR?
  

I would be wary of delivering blood through a dumbwaiter. If someone isn't waiting on the other end, blood could sit there indefinitely. Also, you cannot control who gets the blood out.

• How do you handle a request for more than one unit for a patient?
  

We only allow our OR, ICU, and dialysis to have more than 1 unit at a time on a patient, unless it is a dire emergency. In that case, we treat is just like we do a single unit. We bag each unit with the paperwork separately.

• How do you handle specimens from the ER, OR and CV? Do they go directly to the Blood Bank?
  

Most of our specimens are sent through the tube. All of our blood bank specimens are 'banded.' So, when phlebotomy receiving sees a 'banded' specimen, they know that goes directly to blood bank.

• What is an acceptable TAT for the ER, OR and CV?
  

We have a turnaround time set at 50 minutes for STATS and ERs. This time is measured from the time the specimen was accessioned (the time it reached the lab) to the time it is reported out as 'done' in the computer system. We use the gel, so 50 minutes is a pretty reasonable time to meet.

Also, the AABB has a standards book for tubing blood. That was very helpful in our implementation of using the pneumatic tube system. I would highly recommend it. It has been a learning curve for the nursing staff, but well worth it. I find the coolers work well for surgery patients....although you may have difficut time keeping up with coolers if you are going to be doing livers...they can be quite bloody routinely. For a liver transplant, I would recommend a refrigerator, but then you have to think about the monitoring system. You should be able to have an alarm installed on the fridge that would sound in the blood bank if the temp got out of range. That would be the ideal situation. We keep 3 icepacks in our coolers. That will support 4 units of blood for 12 hours. On rare occassion, we will hand out 2 coolers at the same time on the same patient. This allows the OR to have a total of 8, with minimal stress to the blood bank staff. Proximity to surgery also needs to be considered. Are coolers feasible? We are directly across the hall from surgery (the blood bank is in the main lab). Our new hospital was designed this way to make surgeries easier for the OR and blood bank and it has worked out quite well. If you are considering keeping blood in satellite refrigerators in surgery, this is doable. But you must consider, you must have an audible alarm. If no one is in the surgery suite, who will hear the audible alarm? Is it possible that the alarm could correct itself, and that surgery staff could use blood out of the refrigerator that had, at one time, been out of temp? This is why I would consider a remote alarm that sounds in the blood bank. Someone is always there and will always hear it.